Facts You Thought You Knew - Asthma Control and Ratings
Friday, June 8, 2012 at 10:10AM

It is always worthwhile to revisit Asthma in underwriting guideline. There always seems to be a trend to rate depending on the classification – i.e., Mild intermittent, mild, moderate, or severe persistent.  Classification is also based on the number or type of medications being used. I suggest the medical evidence invites a different approach that would result in applicants being rated in a fairer manner. The death rates for asthma are down in general. The interesting fact for me is that deaths are not directly related to the asthma classification, but rather to the asthma control no matter what the classification. To maintain adequate control requires multiple medications at times - including combination therapies and always including a steroid medication. I suggest that these histories should not be a reason to rate, but rather to give credit to the applicant and then apply the extra ratings to any classification of asthma that shows poor control. Poor control would be indicated by regular use of a rescue inhaler( albuterol ) , frequent clinic, hospital or emergency room visits, and lack of home monitoring through a peak flow meter or other self- monitoring asthma scores.

I’d like to share a recent example of this. An Underwriter asked my opinion about an applicant with a moderate persistent asthma diagnosis coupled with use of an Advair inhaler (combination steroid and long-acting beta –agonist). Based on the guidelines a rating seemed appropriate. I suggested that the medication choice and other parameters in the history showed great control and therefore did not warrant a rating. Although a rating has been traditionally assigned to this group, it is important to look at asthma control and not just medications when classifying. And this is a good thing for our applicants with good control of their asthma and good for the agent and the company as well.

Dr. Nicola Charlton ~ Medical Director at Catholic Financial Life

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